Aspirin, Ibuprofen, Naproxen, Acetaminophen: The Difference Between Over-The-Counter Pain Relievers

Ask folks who work in an office or factory, and they've no doubt heard the question: "Does anyone have an Advil?" People sometimes name a specific over-the-counter pain reliever even when they don't have a particular brand in mind, just as people ask for a Kleenex when they want a tissue of any brand. But there are differences between over-the-counter pain relievers that consumers should understand. Aspirin, ibuprofen, naproxen, and acetaminophen are different substances whose desired effects (and drawbacks) can be different. So if you're not sure how brand names like Advil, Aleve, and Tylenol are different from each other, read on.

Note: this article does not cover topical analgesics, which are pain relievers applied directly to an affected area, or the more powerful prescription pain relievers (like steroids).

Pain Reliever: Aspirin
Over-the-counter brands: Bayer, Bufferin
Ah, good old aspirin - or acetylsalicylic acid, as the science-savvy call it. The first over-the-counter pain reliever to see mass production, aspirin gets absorbed into the bloodstream and essentially "looks" for prostaglandins, substances that are concentrated where we feel pain. In short, aspirin reacts with our blood chemistry to inhibit the enzyme cyclooxygenase, which in turns limits the volume of prostaglandins. As you undoubtedly know, aspirin is used to treat headaches of all sizes, to quell minor body aches and pains, and to reduce inflammation when we're sore. But what are the problems with aspirin as an over-the-counter pain reliever? Among other things, it's rough on the upper digestive tract (can cause upset stomach, heartburn, and even dyspepsia), it's bad for hemophiliacs (because it's an anticoagulant), and it's not always safe for kids (because it's linked to Reye's syndrome). That said, aspirin is still the most common over-the-counter pain reliever, available in both brand names and generic versions. And now it's also playing a role in the treatment of heart disease.

Pain Reliever: Ibuprofen
Over-the-counter brands: Motrin, Advil
Ibuprofen is chemically similar to regular aspirin and functions in an analogous way, minimizing the production of prostaglandins, though it accomplishes this with slightly different chemical reactions. So how is ibuprofen different from aspirin? In lower doses, ibuprofen seems to irritate the esophagus and stomach lining less than its close cousins, aspirin and naproxen. If you have ulcers or acid reflux disease, ibuprofen may be the best product for pain clearly resulting from inflammation (arthritis, sprains, sunburns, etc.).

Pain Reliever: Naproxen
Over-the-counter brands: Aleve
Although it is used for headaches, naproxen is especially effective as an anti-inflammatory agent. For arthritis, sprains, sunburns, and other inflammation-based pain, naproxen seems to edge its competition. Many women suffering from menstrual cramps also report that naproxen is more effective than standard aspirin (but as a man, I can't really confirm that!). The other difference between naproxen and its chemical kin? Similar doses of this over-the-counter pain reliever tend to last longer - often for 8-12 hours instead of 4-8 hours.

Pain Reliever: Acetaminophen (sometimes called paracetamol)
Over-the-counter brands: Tylenol
As they used to sing on Sesame Street: "One of these things is not like the other things!" And such is the case for acetaminophen. This pain reliever lowers fevers and soothes headaches effectively, but it is NOT an anti-inflammatory substance. As a result, it won't do much for arthritis or sprains. Of course, acetaminophen has some key trade-off benefits, including a milder effect on the upper digestive tract than other over-the-counter pain relievers. It is less irritating to the lining of the stomach, making it the best headache treatment for people with acid reflux disease, ulcers, and the like. Acetaminophen is also safer for hemophiliacs and children than aspirin and its friends. There are various permutations of acetaminophen on the market, so be sure to see what else it's partnered with and whether drowsiness may result from the combo. And alas, because its usual dosage for pain relief and its overdose amount are not incredibly different, some doctors consider acetaminophen to be more dangerous than aspirin, arguing that it is easier to overdose unintentionally.

Final note: Always read the dosage instructions on over-the-counter pain relievers and consult a medical professional if you have questions.